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Tuesday, June 22, 2010

3.4 Blood Tests a Day

Our insurance company changed on June 1. The small business that my wife works for switched to United Healthcare, which was only raising rates 14% rather than the 40% hike predicted by Wellpoint Anthem.

In many ways the coverage was similiar to what I've seen in the past, but this new policy brought a new element I'd never experienced before: Blood Test Strip Supply Limits.

The formulary booklet lists all three tiers of test strips, and magically the One Touch Ultra test strips that I use fall into that first category. Lucky me. Of course, there was a fun little code of "SL" in bold behind the brand name. The key at the bottom revealed this to mean, "Supply Limit." It almost brought a smile to my face, as I'd never lived with this type of limit before but had heard the stories from those who have. There's probably no way to avoid a fight on this one, I thought, so bring it on!

In calling UHC on Tuesday to discuss my policy coverage and what this means for my daily D-Management, I spoke with a very nice Helpful Customer Service Girl who answered all of my questions. Sure, the answers weren't all what I would have preferred. But she answered them, and I appreciated that.

She checked her system about my particular brand of BG Test Strip, and informed me that my coverage allowed 102 test strips a month. That smile returned to my face, and I chucked as she went on about something or another that really wasn't relevant to the conversation. Is that what you use, she asked?

Me: "Um, no. I am a Type 1 diabetic, which means I use significantly more than that."

Her: "Oh. How many do you use?"

Me: "I test anywhere from 8 to 10 times a day."

Her: "Oh... Is there a reason you test so many times a day?"

Me: "Yes, there is. I'd like to live past 35 and not lose a leg."

Silence....

Her: "Well, if you use more than that 102 a month, your doctor can request an exception for a higher amount. If that's approved, then you would be able to receive those for the same co-pay."

Co-pay for a month's supply is $10. A three-month supply is $25. That includes mail-order supplier.

Me: "So, my doctor needs to get special approval for the amount of BG strips she thinks is necessary to keep me alive. Ok. But even that requires United Healthcare's approval?"

Her: "Yes, it does."

Me: "What happens if that isn't approved?"

Her: "You can appeal. There is a process in place."

Me: "I see. Ok. Thanks. I understand."

The nice girl answered my questions, and though I wasn't fond of the answers, she provided them kindly and without multiple version of the same story - as is a common happening when talking to health insurance people. I appreciate that. Yet, she just didn't understand why it was necessary for me to be able to test more than three times a day (actually, 3.4 times a day if my math proves correct). Honestly, I don't know what I would do if that amount of daily BG tests was all that was allowed. Any notion of good D-Management would be out the window.

An over-arching message, again, is that is that health insurance companies don't listen to what doctors order and instead want to rely on their own blanket-formulas to limit their own expenses rather than provide what's needed for adequate health care. I get that insurance companies have a bottom line. They want to make sure policy-holders are actually obtaining what they will actually need and use, because test strips are very expensive and way too costly. But too often, these companies fail to recognize a basic reality: that People With Diabetes generally will use more test strips than what might have been otherwise ordered. With BG Meters being notoriously inaccurate by 20% or so, you might get an inadequate blood message or another error that means using another strip. Or you might have to test more than once at any given time to make sure the insulin you're giving yourself won't take you too Low and lead to bad things. In the event of a Low, you have to test MULTIPLE times to ensure that you're back to safe levels.

You know, the practical considerations of BG Testing for People With Diabetes.

So, we do what we must to battle the insurance and financial woes necessary to obtain these needed supplies. Those us with insurance have it well, compared to those who don't and have to dole out the insane amounts for few strips. I'd just endured a hellish process with my previous insurer and mail-order supply company to receive a covered 3-month supply of strips. You may remember my rants about that - here and here. This exact discussion and Supply Limit issue is exactly why I made sure to order those strips early through the former insurer, to make sure that I had enough on hand in case there was some crazy delay or limitation. Looks like my thinking was pretty much on cue, after all.

So, in the next week, I'll contact my Endo's Office to fill her in on this new prescription hurdle and have her do what's necessary. There is hope that I won't have to appeal and United Healthcare will see the logic in providing what my doctor has deemed medically necessary for my D-Care. Yet, confidence in that result is not as strong. It's a hope that lingers, like the hope for a Cure. But it doesn't change the fact that we must Live With Diabetes in the meantime, and use the process that's in place - for better or worse.

This does make me wonder, though... Would the insurance industry be willing to do what some in the Pharma have done: listening to the Diabetes Community about their concerns, likes, and dislikes? Roche has reached out to the Diabetes Online Community and Minimed has done the same in Europe. But what about Wellpoint Anthem, or Blue Cross, or Cigna, or Aetna? Would those players be willing to listen to those who feed their bottom line? Is this worth advocating for, or would it just be a waste of time? We'll see what the future holds on this one.

12 comments:

Health insurance, contrary to what some may claim, makes money by denying claims, and perhaps more importantly, does not make money by assuring long-term outcomes, they only care short-term outcomes since the odds are high that you won't be with the same carrier in 30 years. All of this explains limits on testing supplies. My appeal on this arbitrary limit took 9 months, but I finally succeeded, although not without persistence. Good thing I piggy banked some extra stock before my company switched from the old plan, but that's still only 90 days worth. Still, you raise an interesting point about how likely the healthcare insurance companies would be to meet with us collectively as a group? WellPoint seems very unlikely given their dominance in the individual insurance market, but some of the others might be interesting!

That's just plain insane! I can't believe they only average out to 3.4 tests per day! That's below the standard 4. They're just trying to get away with issuing you only one box instead of two. (or, in our case, 3 per month). Stupid underwriters. They don't care because they don't live with our disease, and they'll take the word of some stupid doctor that really has no clue what we need instead of consulting a good endocrinologist.I hope that you get the approval without having to go through a denial/appeal process. Crossing my fingers for ya!

I've had UHC both under corporate and private plans. The corporate plan covered ALL my diabetes meds and supplies (and continues to cover The Other Half's) at zero copay, and no limitation, so long as it has been prescribed by the doctor. (I currently have a copay that is a percentage of the retail cost.) In September I will be moving to a different provider and system under which diabetes supplies are supposed to be completely covered. (I will see once I'm covered by that plan/system/provider.)

I suspect the health insurance provider is going by the Medicare formulary, which allows 1 test per day for those on oral meds, and 4 tests per day for those on insulin. (Remember that Medicare recipients are mostly over 65 years of age, even more overwhelmingly Type 2 than the general population, may often have issues of forgetfulness, and may be so tight on funds as to not be able to afford the copays... )

This is so weird because I have united and I had no problem increasing my test strip usage from 5/day to 10/day last summer. I get 900/month from MedCo for a 50 dollar copay. My doctor just re-wrote my prescription for 10 tests per day and sent it to Medco and a few weeks later I had my box of 900 test strips. Bada bing bada boom. But believe me United and I have had our share of round and rounds. Like fighting over how much INSULIN they should give me. Insurance scams people who depend on it for their LIFE. It's a mess.

After reading this, I had to check my 4 week trends summary. Since going on the CGM my BS checking has increased, partially due to calibration, part due to knowing sooner I am going low and checking it. Anywho, I'm at 9.1 checks per day. Guess I would burn through that supply fairly quickly. Heck, that doesn't even include the readings from my One Touch Mini that I forget to enter into the pump.

Wow, what a feakin' mess. I hate how people question the amount we test a day. We do it that often to stay on top of this disease! Geez. I hope that the process ends with the endo's request for more test strips and you don't have to appeal anything. That just sucks butt.

I always expect that insurance customer service ppl will questiion and not "get" why we test so often but I was shocked when the nurse for my nephrologist questioned why I test 8-10 a day? I looked at her like she had three heads.Well anyway, I too have UHC and when I started using pump therapy last Fall, my testing went from 6-8x per day to 8-10 or more some times. Also taking into account an increase for lows and for test/pump errors. My current plan allows 8 strips per day and reqires approval for more. I also have a few backup meters in case my OmniPod PDM malfunctions in the meter. (which it has) So who pays for anything above and beyond 8 per day, and who pays for any amount of strips for your backup meters? We do, and I have. I refuse to test less.I don't know the answer, just frustrated.

My diabetes control would be awful if I could only test 3 times a day. I've recently realised that I need to test at least three times in a row with about 15 minutes in-between to get any real idea of what my BG is doing because it's always going up or going down, never staying still. I don't know why why it took me 20 years to figure this out... On the one hand I'm very glad I live in a country with subsidised healthcare which allows me as many blood test strips as I want without needing insurance... on the other hand it also means I would have to pay an arm and a leg for a CGMS.

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